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Quick screening

About your drinking

How often do you have a drink containing alcohol?

Answer honestly — this isn’t a test, it just helps a provider make a safe decision. Takes about 3 minutes.

How often do you have a drink containing alcohol?
About your drinking

How many drinks do you have on a typical day when you’re drinking?

How many drinks do you have on a typical day when you’re drinking?
About your drinking

How often do you have 6 or more drinks on one occasion?

How often do you have 6 or more drinks on one occasion?
Your goal

What are you hoping to do?

What are you hoping to do?
Where you live

Which state are you in?

Your provider has to be licensed where you are, so this decides who can treat you.

Safety check

Are you currently pregnant or breastfeeding?

These help a provider keep you safe. Answer honestly — nothing here disqualifies you from getting help, it just affects what kind of care makes sense.

Are you currently pregnant or breastfeeding?
Safety check

Have you used opioids (prescription painkillers, heroin, fentanyl, etc.) in the last 7 days?

Have you used opioids (prescription painkillers, heroin, fentanyl, etc.) in the last 7 days?
Safety check

Have you ever had a seizure?

Have you ever had a seizure?
Safety check

When you’ve stopped or cut back drinking before, have you had shaking, sweating, hallucinations, or a seizure?

When you’ve stopped or cut back drinking before, have you had shaking, sweating, hallucinations, or a seizure?
Safety check

Have you ever had a bad reaction to naltrexone (Vivitrol, ReVia)?

Have you ever had a bad reaction to naltrexone (Vivitrol, ReVia)?
Safety check

Have you been told you currently have active hepatitis or liver failure?

Have you been told you currently have active hepatitis or liver failure?